The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama

by Deppisch, Ludwig M. , M. D.

  The much-overlooked 1901 memorial statue on Scott Circle in Washington, D.C., that depicts Samuel Hahnemann, the founder of the homeopathic medical discipline (Library of Congress).

  At the turn of the twentieth century, American homeopathy peaked in influence and adherents. In 1900 between 8 and 10 percent of physicians were homeopaths. Twenty-two homeopathic medical schools were extant in 1900, and in 1898 American homeopathy hosted nine national medical societies, thirty-three state medical societies, eighty-five local societies, sixty-six general homeopathic hospitals, seventy-four specialty homeopathic hospitals, fifty-seven homeopathic dispensaries, and thirty-one medical journals. Towards the end of the nineteenth century, orthodox doctors discovered a need to cooperate with homeopaths in order to effect meaningful state licensure laws. Both groups of physicians realized that unity was required to ensure a system of quality health care, The coalition’s goals were twofold: To drive incompetent doctors from the practice of medicine and to limit the prerogatives of newer medical sects—chiropractors, osteopaths and Christian Scientists.5

  Drs. Sawyer (62 years old) and Boone (32 years old) were trained during different eras; both were involved in the care of first lady Florence Harding, and Boone treated first lady Grace Coolidge. Their White House tenures provided opportunities to contrast their medical knowledge and degree of homeopathic parochialism.

  Charles Sawyer and the Harding Family

  Dr. Charles Sawyer was an 1881 graduate of the Homeopathic Hospital College of Cleveland. Sawyer was very prominent in homeopathic circles, as president of the Ohio State Homeopathic Medical Society and the American Institute of Homeopathy. In addition he authored articles that appeared in the Journal of the American Institute of Homeopathy.6

  His connection to the Harding family dated to July 1897. Future president Warren Harding’s mother, Phoebe Harding, was a practicing homeopathic physician who was accused of negligence in the death of a patient. Sawyer, then a prominent physician in the same Ohio town, was called in as a consultant in the legal controversy. His testimony supported Dr. Harding’s professional performance, saving her practice from ruination. The local newspaper commented, “This statement, from a man of Dr. Sawyer’s ability and standing in the community, relieves Mrs. Harding from all responsibilities in the affair.”7

  Subsequently “Doc” Sawyer and his wife became very friendly with Warren Harding and his wife, Florence. Their friendship was possibly due to the homeopath’s beneficial intervention in the Phoebe Harding malpractice case, or perhaps it was a natural result of social companionship between two “power couples” in a small mid–America town. Both Hardings became increasingly dependent upon Sawyer for their medical care, Florence, almost obsessively so. Sawyer’s medical responsibility for Mrs. Harding lasted until his death in 1924.8

  Florence (The Duchess) Harding

  Two Decades of Kidney Disease

  Florence Kling DeWolfe, a determined and independent single mother of one, married up-and-coming Warren Gamaliel Harding, a man five years her junior, in July 1891. Called the Duchess by her husband and many others,9 she was forceful, competent and smart. The Duchess effectively managed Harding’s career as a newspaper publisher and a politician. Her thirty-three-year marriage with Harding produced no children.

  Florence Harding’s first recorded battle with kidney disease forced the cancellation of the Hardings’ planned cruise to Cuba. In early 1905 Florence was admitted to Grant Hospital, Columbus, Ohio, with acute renal failure. The diagnosis was a “floating kidney” with obstruction of its ureter. “Floating kidney” was then a somewhat popular diagnosis; it referred to an abnormal descent of a kidney from its normal position when the patient was recumbent upon the patient’s standing upright. More common in women, it rarely produced sufficient ureteral kinking or bending to cause an obstruction to the normal flow of urine into the bladder. Complications included infection of the affected kidney with severe cramping pain, and more serious, the retention of toxic products, so-called uremic poisoning.10

  Unfortunately for Mrs. Harding, severe ureteral blockage had occurred and uremic poisoning ensued. On February 24, 1905, Dr. James Fairchild Baldwin elected to wire the affected kidney in place. He did not perform a nephrectomy because of previous “heart damage.” Heart disease, without any specificity or documentation, became a frequent allusion during the rest of the Duchess’s life.11 Her postoperative convalescence was lengthy, requiring hospitalization for eight months. The surgical wound required dressings twice daily. Her surgeon, Dr. Baldwin, a graduate of Jefferson Medical College, was considered “in his day … the equal of any surgeon in America.” He was the founder of Grant Hospital, then the largest hospital in the United States.12 A minor relapse of Mrs. Harding’s kidney ailment occurred in spring 1908. It placed the Duchess once again under Doc’s care: “As the summer wore on, she grew increasingly dependent upon his homeopathic concoctions for all her physical problems, real and imagined, believing Doc was the one man who could keep her alive…. It was the beginning of her complex emotional yet unromantic entanglement with him.”13

  Florence Harding, the wife of Warren Harding. She was a strong believer in homeopathic medicine (Library of Congress).

  Four years later, in 1912, the Duchess made frequent visits to the Sawyer-owned White Oaks Sanatorium for physical and psychological respite.14 The entrepreneurial Sawyer moved his health care facility from downtown Marion, Ohio, to the rural White Oaks Sanatorium, where he constructed fourteen bungalows placed around a central courtyard. An enclosed hall called the Cloister encircled the courtyard and connected all of the buildings. Sawyer promoted White Oaks “as a haven from the cares of the world, a place where patients could relax and reap the full benefits that nature’s bounty and modern medicine could provide.” His enterprise was advertised as a respite for those afflicted by nervous diseases and mental disorders. Treatments included “rigorous outdoor exercise, light therapy, hydrotherapy, massage and electrotherapy.”15

  Sawyer’s son, Carl, a 1906 graduate of the allopathic Rush Medical School in Chicago, joined his father at White Oaks, and thereby became involved in the care of Florence Harding. The younger Sawyer eventually was certified by the American Board of Psychiatry and Neurology. Carl Sawyer’s transition from homeopathy to orthodoxy reflected the friendly coexistence of the two branches of medicine that began around 1900.16

  Another serious kidney attack occurred in December 1912 and persisted into 1913. The Sawyers treated the Duchess with unspecified measures at White Oaks. The gravity of the attack was underscored by the senior Sawyer’s prognosis that his patient was not expected to live. Doc attributed its onset and severity to an underlying cardiac condition. References to Mrs. Harding’s diseased heart abound, but its nature was never clarified.17 An episode in autumn 1915 was treated by the elder Sawyer. This was considered mild, since Mrs. Harding insisted in journeying to Washington, D.C., to witness her husband take the oath as the new United States senator from Ohio. This proved to be unwise, as a relapse occurred.18

  In January 1916, the then-senator’s wife became ill with heart palpitations, acute indigestion, pain, abdominal swelling and severe “flu.” Residing in the District of Columbia and distant from the amenable ambience of the Sawyers and their White Oaks Sanatorium, the Hardings elicited the services of the esteemed Washington practitioner Dr. Sterling Ruffin. The doctor was nonpartisan, treating both the Democratic Wilsons and the staunch Republican Duchess. Ruffin’s examination detected no evidence of renal dysfunction. However, in Florence’s opinion, Ruffin did not measure up to Sawyer’s talents. In a dismissive tone she opinion: “This Washington doctor … I never want to see him.” Sawyer, summoned from White Oaks, arrived in Washington and dosed his loyal patient with his homeopathic regimen of “dark pellet,” “green medicine,” “flat white tablets,” and “yellow pellets.” Mrs. Harding recovered.19

  Another severe attack occurred in November 1918, the most menacing since the initial episode in 1905
. The kidney had swollen to ten times its normal size and, in the words of her husband, was “far more painful than you can imagine.” The diagnosis was hydronephrosis secondary to obstruction of the ureter. Carl Sawyer, then stationed as an army doctor at nearby Fort Meade, attended, together with Dr. Bernard Hardin, who practiced in several District hospitals. Surprisingly, Mrs. Harding liked Hardin. Four years later, she sent him flowers and also a letter of concern over the doctor’s ill health, possibly as a reflection of her satisfaction and appreciation for his earlier service to her. Despite this, she took only the pills prescribed by the senior Dr. Sawyer.20

  Since Mrs. Harding was convinced that only Doc Sawyer could keep her alive in the White House, her husband insisted that Sawyer become the White House physician. However, the inducements of a brigadier general’s appointment and additional bureaucratic titles were required to lure Sawyer from his lucrative White Oaks practice to Washington, D.C.21

  Doc Sawyer kept the first lady alive during a near-fatal medical emergency during August and September of 1922. While on an August 25–27 cruise aboard the presidential yacht the Duchess developed indigestion. Fortunately, Sawyer correctly suspected a recurrence of kidney disease and confined his patient to her White House bed.22 Initially the illness was described as “an ailment neither alarming nor serious … due to the effects of a cold complicated with a recurrence of a hydronephrosis.” The patient’s condition gradually worsened until September 7, when great pain caused President Harding to summon Dr. Joel Boone, then Sawyer’s assistant, to her bedside. The following day Florence Harding developed uremic toxicity and nearly died. The alarmed president said to a friend, “I am afraid that Florence is going.”23

  Sawyer, frightened as his patient’s condition worsened, relied heavily on Dr. Boone and, in addition, urged both his son Carl and the president’s cardiologist brother, George Harding, to hurry to Washington from Ohio. In this VIP’s medical emergency Doc sought both safety and solace in numbers. He enlisted expert surgical consultations from the renowned Rochester, Minnesota, surgeon, Dr. Charles Mayo, who in turn brought in Dr. John Finney, chief of surgery at Baltimore’s Johns Hopkins.

  President Harding insisted on full transparency for his wife’s medical condition. This was one of the few times that the seriousness of a first lady’s illness was presented to the country in complete detail. Harding was mindful of the recent political controversy attached to the secrecy of President Woodrow Wilson’s stroke.24 On September 8, Sawyer released the following statement to the press: “Mrs. Harding, whose illness is a recurrence of attacks before coming to the White House developed complications Thursday and Thursday night which made her condition critical. These complications are so serious that recovery is not yet assured. Doctor John Finney of Baltimore was called in consultation tonight and Dr. Charles Mayo is en route from Rochester, Minnesota. Doctor Carl W. Sawyer and Doctor Joel T. Boone have joined in the attendance of Mrs. Harding today.” After this announcement, twice daily medical bulletins were released until the first lady was out of danger. A Philadelphia newspaper editorialized that such disclosure was “striking in comparison with the attitude of the previous Administration as to compel notice.”25

  When Dr. Finney arrived at the bedside from Baltimore on September 8, he: “found her very ill, suffering from an acutely infected cystic kidney. Her pulse and temperature were high, and she appear[ed] very toxic.” The consultant confirmed Sawyer’s diagnosis of hydronephrosis of the affected kidney. This diagnosis, literally “water inside the kidney,” refers to distention of the affected kidney’s urine collection and excretion system with destruction of its ability to function. Finney advised as treatment the comparatively simple procedure to surgically drain the kidney by incision. Finney’s autobiography continued the story: “This course, however, did not appeal to Dr. Sawyer…. I insisted on seeing the president before going and stating the case to him as I saw it. Dr. Sawyer again objected, and so the matter was up to the President who sided with Dr. Sawyer. I returned to Baltimore.”26

  Dr. Charles Mayo arrived on September 9 and insisted that Finney return to Mrs. Harding’s bedside. The patient’s condition remained dire. Finney resumed his lively narrative: “Dr. Mayo … strongly advised drainage of the kidney by incision…. [O]ne had to be a bit dogmatic. Perhaps nature would come to the rescue, perhaps not. If not, the chances of recovery were practically nil…. Dr. Sawyer again disagreed and said that he did not believe much in operating anyway. The question was once more put up to the President … [who] again decided in favor of Dr. Sawyer and against the operation both Dr. Mayo and I advised. It was a new experience, I am sure, for Dr. Mayo, coming from the Mayo Clinic, to have his opinion and advice summarily disregarded. I was more accustomed to it in the East.”27 Shortly thereafter, nature did take its course. The urine flow occurred and the first lady recovered, albeit very slowly. Letters written as late as February 1923 indicated that Florence Harding’s convalescence was protracted.28

  Thus a poorly educated homeopathic doctor was able to stare down two of the most illustrious and respected surgeons in America and have his decision “to watch and wait” vindicated.

  Dr. Charles H. Mayo founded and led the renowned Mayo Clinic with his older brother, William, in Rochester, Minnesota: “The names of William and Charles Mayo are famous throughout the world wherever surgery is practiced.” Upon entry of the United States into World War I, the brothers Mayo were made joint chief consultants in charge of all the surgical services in the United States Army.29 John Finney was a graduate of both Princeton University and the Harvard School of Medicine. He was second in rank on the surgical staff of Johns Hopkins Hospital until Dr. William Halsted’s death in 1923, and for two years served as acting professor of surgery and chief of service at Johns Hopkins Hospital and Medical School. Finney was much admired for his public spirit and as an educator.30

  John Finney met Mrs. Harding socially several times thereafter at the home of Mrs. Evalyn McLean. He further wrote: “I was called on the telephone from the White House by Mrs. Harding herself, who cordially invited me to join the presidential party as a member of the medical group. She said that, as I already knew, she had not been very well and neither had the President, and they would appreciate it if I would join them on their trip to the West Coast and Alaska.” Although the surgeon regretted that he could not accept, Finney maintained contact with the presidential party by telegram.

  President Warren Harding died from a heart attack in San Francisco on August 2, 1923, almost one year from the onset of his wife’s near-fatal illness.31 In stark contrast to his deft handling of the Duchess’s kidney disease, Sawyer seriously misdiagnosed and mismanaged the heart disease of her husband.32 After President Harding died at age fifty-seven, the widowed first lady went back to Marion, Ohio. In January 1924 former first lady Florence Harding returned to Washington. She was accompanied by the wife of Dr. Charles Sawyer, and upon her arrival she took up residence in an apartment at the Willard Hotel.33 Dr. Joel Boone offered to care for Mrs. Harding after the senior Sawyer resigned as White House physician. However, Doc was determined to retain his position as Florence Harding’ s personal physician. Six months after Mrs. Harding took up residence in the nation’s capital, her kidney disease recurred. Sawyer immediately traveled to Washington and refused to leave until Mrs. Harding accompanied him back to his Ohio sanitarium. There she remained under the watchful care of the Sawyers.34

  On November 3, 1925, Carl Sawyer released a bulletin that Florence Harding was again suffering from nephritis and had severe abdominal pain. The younger Sawyer was quoted at the time: “She has developed a number of symptoms that were present in her serious attack in 1922 in the White House. Other complications have arisen which were not present at that time, and her condition now is rather serious.” Sawyer requested outside surgical consultation. In a strange addendum he identified the death of his father as a factor contributing to the deterioration of his patient.35

  On November 8
, Drs. Wood (of Cleveland) and Carl Sawyer performed an exploratory operation at White Oaks. James Craven Wood was a pillar of the Midwest Homeopathic community and specialized in obstetrics and gynecology. Their surgery report stated there was “an almost complete contusion of the right ureter, necessitating an exploratory puncture, which is hoped will afford temporary relief.” The patient survived the palliative operation, but her respite was brief. She died on November 21, 1924. Sawyer listed the cause of death as chronic nephritis and myocarditis, with evidence of hydronephrosis.36 Charles Sawyer had died suddenly, at sixty-four years of age, at his White Oaks Sanatorium on September 23, 1924, outliving his famous patient, the president, by just over one year. Florence Harding, then residing at White Oaks, was the last person to see Doc alive.37

  Grace Goodhue Coolidge

  Grace Goodhue Coolidge, Florence Harding’s successor as first lady, was a stark contrast to her flamboyant predecessor, dissimilar in personality, in political influence, in controversy, and in longevity. However, there were two similarities. Both women nearly died in the White House from a similar kidney infection. Both were under the care of the assistant White House physician, navy doctor Joel Boone.